Composition and method for compounded therapy

ABSTRACT

The present embodiments relate to topically delivered compounded medications. A transdermal cream may provide the effective topical administration of multiple medications simultaneously. The transdermal cream may include low concentrations of local anesthetics, a NSAID, an anticonvulsant, and/or other active ingredients. The transdermal cream may include lidocaine, prilocaine, meloxicam, and lamotrigine and/or topiramate. Alternatively, the transdermal cream may include a lidocaine/prilocaine base cream to which is added a fine powder of one or more ground up medications to form a compounded medication. The compounded medication in powder form may be generated from grinding up tablets of NSAIDs, anticonvulsants, nerve depressants, antidepressants, muscle relaxants, NMDA receptor antagonists, opiate or opioid agonists, and/or other agents. The compounded medication in powder form may include meloxicam, lamotrigine, topiramate, other active ingredients, and DMSO or Sterile Water for Irrigation. In another aspect, the present embodiments relate to methods of compounding medications and transdermal creams or gels.

FIELD OF THE INVENTION

This patent application is a continuation of co-pending U.S. patentapplication Ser. No. 13/448,088 entitled Composition and Method forCompounded Therapy, filed Apr. 16, 2012, which is a continuation-in-partof U.S. patent application Ser. No. 13/337,598, entitled Composition andMethod for Compounded Therapy, filed Dec. 27, 2011, now abandoned, bothof which are herein incorporated by reference in their entirety.

BACKGROUND

Transdermal creams are employed to deliver medication to the skin of apatient. Conventional compositions intended for topical administrationinclude EMLA cream, a eutectic mixture of lidocaine and prilocaine in anemulsified topical cream, such as disclosed by U.S. Pat. Nos. 6,299,902and 4,562,060, which are incorporated herein by reference in theirentireties. However, conventional transdermal creams may include variousdrawbacks, such as addressing limited medical conditions, creatingadverse side effects, and/or having limited shelf lives. Additionally,conventional methods of manufacturing transdermal creams may beinefficient and/or lack precision with the amount of active ingredients,or have other drawbacks.

SUMMARY

The present embodiments may relate to topically delivered compoundedmedications for treatment of various ailments, such as pain,osteoarthritis, epilepsy, inflammation, muscle fatigue, spasms, and/orother ailments. In one aspect, a transdermal cream for the effectiveadministration of multiple medications simultaneously for one or moreailments may be provided. The transdermal cream may include lowconcentrations of lidocaine, prilocaine, meloxicam, and lamotrigineand/or topiramate. Alternatively, the transdermal cream may include abase having lidocaine and prilocaine to which is added a fine powder ofone or more medications. The medication in powder form may be generatedfrom grinding up tablets of NSAIDs (Non-Steroidal Anti-InflammatoryDrugs), nerve depressants, anticonvulsants, antidepressants, musclerelaxants, anesthetics, and/or other active ingredients. The presentembodiments also relate to methods of making the compositions discussedherein.

In one aspect, a transdermal cream that permits the simultaneousadministration of multiple medications in low concentrations may beprovided. The transdermal cream may include lidocaine in an amountbetween approximately 0.5% and approximately 7.0% by weight of thetransdermal cream; prilocaine in an amount between approximately 0.5%and approximately 7.0% by weight of the transdermal cream; meloxicam inan amount between approximately 0.01% and approximately 5.0% by weightof the transdermal cream; and lamotrigine in an amount betweenapproximately 0.5% and approximately 5.0% by weight of the transdermalcream. In one embodiment, the transdermal cream may compriseapproximately 2.0% by weight of both lidocaine and prilocaine,approximately 0.09% by weight meloxicam, and approximately 2.5% byweight lamotrigine. As a result, the transdermal cream may allow for thetopical administration of lidocaine, prilocaine, meloxicam, andlamotrigine simultaneously during use.

In another aspect, a transdermal cream that permits the simultaneousadministration of multiple medications in low concentrations may beprovided. The transdermal cream may include lidocaine in an amountbetween approximately 0.5% and approximately 7.0% by weight of thetransdermal cream; prilocaine in an amount between approximately 0.5%and approximately 7.0% by weight of the transdermal cream; meloxicam inan amount between approximately 0.01% and approximately 5.0% by weightof the transdermal cream; and topiramate in an amount betweenapproximately 0.5% and approximately 5.0% by weight of the transdermalcream. In one embodiment, the transdermal cream may compriseapproximately 2.0% by weight of both lidocaine and prilocaine,approximately 0.09% by weight meloxicam, and approximately 2.5% byweight topiramate. As a result, the transdermal cream may allow for thetopical administration of lidocaine, prilocaine, meloxicam, andtopiramate simultaneously during use.

In another aspect, a method of compounding one or more medications witha transdermal cream for the topical administration of a compoundedtherapy may be provided. The method may include grinding up one or moretablets of a NSAID, an anticonvulsant, a nerve depressant, a musclerelaxant, a NMDA (N-Methyl-D-aspartate) receptor antagonist, an opiateor opioid agonist, and/or antidepressant into a fine powder ofmedication. The method may also include adding the fine powder ofmedication to a transdermal cream or base composition containing bothlidocaine and prilocaine, the transdermal cream including both lidocaineand prilocaine in an amount of between approximately 0.5% andapproximately 7.0% by weight of the transdermal cream, respectively. Themethod may include adding the fine powder of compounded medication tothe starting transdermal cream or base composition in a sufficientamount such that the final transdermal cream includes the compoundedmedication that is ground up in a low amount of between approximately0.01% and approximately 5.0% by weight of the transdermal cream. In oneembodiment, an amount of ground up medication is added to the basecomposition such that the final transdermal cream contains lowconcentrations of several active ingredients and is approximately 2.0%by weight lidocaine, approximately 2.0% by weight prilocaine,approximately 0.09% by weight meloxicam, and approximately 2.5% byweight either lamotrigine or topiramate.

In another aspect, a method of compounding medications with atransdermal cream for the topical administration of a compounded therapymay be provided. The method may include grinding up tablets of two ormore medications into a fine powder of compounded medication. The two ormore compounded medications to be ground up may be selected from aNSAID, an anticonvulsant, a nerve depressant, a muscle relaxant, a NMDAreceptor antagonist, a local anesthetic, an antidepressant, and anopioid or opiate agonist. The method may include adding the fine powderof compounded medication to a transdermal cream or gel such that thetransdermal cream or gel allows for topical delivery of the two or morecompounded medications for simultaneous treatment of two or moreailments when the transdermal cream or gel is topically applied.

In another aspect, the present embodiments may include the presence ofdimethyl sulfoxide (DMSO) and/or Sterile Water for Irrigation,Alternatively, the transdermal cream of the present embodiments may becompounded to have no bulk ingredients in it. For instance, during themethods discussed herein, the DMSO may be removed and replaced withSterile Water for Irrigation or other purified water. The transdermalcream may be essentially or entirely DMSO-free.

The above-described and other features and advantages of the presentdisclosure will be appreciated and understood by those skilled in theart from the following detailed description, drawings, and appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

There is shown in the drawings embodiments which are presentlypreferred, it being understood, however, that the invention can beembodied in other forms without departing from the spirit or essentialattributes thereof.

FIG. 1 depicts an exemplary method of compounding; and

FIG. 2 depicts another exemplary method of compounding.

DETAILED DESCRIPTION OF THE INVENTION

The present embodiments may relate to topically delivered compoundedmedications for treatment of various ailments, such as pain,osteoarthritis, epilepsy, inflammation, muscle fatigue, spasms, and/orother ailments. In one aspect, a transdermal cream for the effectiveadministration of multiple medications simultaneously for one or moreailments may be provided. The transdermal cream may include lowconcentrations of lidocaine, prilocaine, meloxicam, lamotrigine and/ortopiramate, and other active ingredients.

Alternatively, the transdermal cream may include a base having bothlidocaine and prilocaine, and to which is added a fine powder of one ormore medications. The medication in fine powder form may be generatedfrom grinding up tablets of NSAIDs (Non-Steroidal Anti-InflammatoryDrugs), anticonvulsants, nerve depressants, muscle relaxants, NMDA(N-Methyl-D-aspartate) receptor antagonists, opiate or opioid agonists,antidepressants, and/or other active agents. The fine powder may allowfor precise amounts of the active ingredients to be added to the base.The transdermal cream may exhibit excellent storage characteristics, andavoid separation and/or degradation of the active ingredients from thebase for substantial lengths of time.

In one aspect, a transdermal cream may include lidocaine in an amountbetween approximately 0.5% and approximately 7.0% by weight of thetransdermal cream; prilocaine in an amount between approximately 0.5%and approximately 7.0% by weight of the transdermal cream; meloxicam inan amount between approximately 0.01% and approximately 5.0% by weightof the transdermal cream; and lamotrigine and/or topiramate in an amountbetween approximately 0.5% and approximately 5.0% by weight of thetransdermal cream. As a result, the transdermal cream may allow for thetopical administration of lidocaine, prilocaine, meloxicam, andlamotrigine and/or topiramate simultaneously during use. In oneembodiment, the transdermal cream may comprise approximately 2.0% byweight lidocaine and prilocaine, respectively; approximately 0.09% byweight meloxicam; and approximately 2.5% by weight either lamotrigine ortopiramate.

In another aspect, a method of compounding one or more medications witha transdermal cream for the topical administration of a compoundedtherapy may be provided. The method may include grinding up one or moretablets of a NSAID, an anticonvulsant, a nerve depressant, a musclerelaxant, a NMDA receptor antagonist, antidepressant, and/or an opiateor opioid agonist into a fine powder of medication. The method may alsoinclude adding the fine powder of medication to a transdermal creamcontaining both lidocaine and prilocaine, the transdermal creamincluding both lidocaine and prilocaine in an amount of betweenapproximately 0.5% and approximately 7.0% by weight of the transdermalcream. The method may include adding the fine powder of medication tothe transdermal cream in a sufficient amount such that the transdermalcream includes the medication that is ground up in an amount of betweenapproximately 0.01% and approximately 5.0% by final weight of thetransdermal cream.

The fine powder may be a fine powder of compounded medication thatincludes two or more active ingredients. For example, the activeingredients may comprise a NSAID, such as meloxicam, and a nervedepressant or an anticonvulsant, such as lamotrigine and/or topiramate.In one embodiment, an amount of ground up compounded medication is addedto the base such that the final composition of the transdermal creamafter the fine powder of compounded medication is added is approximately2.0% by weight lidocaine, approximately 2.0% by weight prilocaine,approximately 0.09% by weight meloxicam, and approximately 2.5% byweight either lamotrigine or topiramate.

I. Compositions for Compounded Therapy

The present embodiments may relate to a compounded medication program.The compounded medication program may address several ailmentssimultaneously. In one aspect, the present embodiments may be intendedto intended to minimize skin damage or irritation caused by the topicaladministration of various medications. Administering low doses orapplying transdermal creams or gels with low concentrations of one ormore active ingredients may minimize adverse side effects, such as sideeffects that develop with prolonged usage.

For instance, Stevens-Johnson Syndrome (SJS) and toxic epidermalnecrolysis (TEN) are two forms of life-threatening skin conditions. SJSis a potentially deadly skin disease that usually results from a drugreaction. Drugs that have been linked to SJS include, but are notlimited to: NSAIDs, allopurinol, phenytoin, carbamazepine, barbiturates,anticonvulsants, and sulfa antibiotics. However, almost any drug(prescription or over-the-counter) could potentially cause SJS if asevere enough allergy is present.

The onset of severe symptoms in drug related SJS may not appear for 1-2weeks after first taking the drug causing the allergic reaction. Initialnon-specific symptoms such as coughing, aching, headaches, fevers,vomiting, and diarrhea are commonly seen. These symptoms are usuallyfollowed by a red rash across the face and trunk of the body, laterfollowed by blisters, and in some situations the nails and hair begin tofall out.

SJS is a very serious and potentially deadly condition and should betreated accordingly. Discontinuation of the medication and treatment ofthe “new infection” with a suitable antibiotic is the first step. Insome situations, a patient is treated in a burn unit if necessary.However, compounded therapies may administer lower doses of activeagents topically, and thus the effect of any adverse skin reaction maybe lowered due to the lower doses of agent that the patient is allergicto.

In view of the foregoing, the present embodiments may include providing,within a base composition, several medications that address differentailments. The medications may be mixed in low concentrations to minimizeany adverse reaction to the topical cream or gel containing the severalmedications.

The medications may be mixed with the base composition for topicaladministration to a patient. The medications may include one or morelocal anesthetics, such as lidocaine, prilocaine, or benzocaine; one ormore NSAIDs, such as meloxicam; and one or more nerve depressants and/oranticonvulsants, such as gabapentin, topiramate, or lamotrigine. Themedications may also include one or more muscle relaxants, such asbaclofen or cyclobenzaprine; one or more NMDA receptor antagonists, suchas ketamine; and/or one or opiate or opioid agonists, such as C2 or C3opiate agonists, or tramadol.

II. Meloxicam/Lamotrigine/Lidocaine/Prilocaine Compounded Medication

In one aspect, a transdermal cream or gel may include lidocaine,prilocaine, meloxicam, and lamotrigine. Lidocaine and prilocaine areamide-type local anesthetic agents. They may come in commerciallyavailable creams.

The amount of lidocaine and prilocaine in the transdermal cream may beapproximately the same. The amount of lidocaine and prilocaine may eachbe between approximately 0.5% and approximately 5.0% of the total weightof the transdermal cream. Alternatively, the amount of lidocaine andprilocaine may each be between approximately 1.0% and approximately 4.0%of the total weight of the transdermal cream, or between approximately1.5% and approximately 3.0% of the total weight of the transdermalcream. In one preferred embodiment, the amount of lidocaine andprilocaine may each be approximately 2.0% of the total weight of thefinal transdermal cream or gel.

Meloxicam is a NSAID that may provide pain relief, such as pain relieffor osteoarthritis or rheumatoid arthritis. In one aspect, the amount ofmeloxicam in the transdermal cream or gel may be less than that of theother active ingredients.

The amount of meloxicam in the transdermal cream may be betweenapproximately 0.01% and approximately 5.0% of the total weight of thetransdermal cream, or between approximately 0.03% and approximately 3.0%of the total weight of the transdermal cream. Preferably, the amount ofmeloxicam may be between approximately 0.05% and approximately 0.15% ofthe total weight of the transdermal cream. In one preferred embodiment,the amount of meloxicam may be approximately 0.09% of the total weightof the transdermal cream or gel.

Lamotrigine may be characterized as an anticonvulsant. It may be used asan antiepileptic drug to treat epilepsy or bi-polar disorders. In oneaspect, the amount of lamotrigine in the transdermal cream or gel may bemore than the other active ingredients, such as lidocaine, prilocaine,meloxicam, and/or other active ingredients.

The amount of lamotrigine in the transdermal cream may be betweenapproximately 0.5% and approximately 5.0% of the total weight of thetransdermal cream, or between approximately 1.5% and approximately 3.5%of the total weight of the transdermal cream. Preferably, the amount oflamotrigine may be between approximately 2.0% and approximately 3.0% ofthe total weight of the transdermal cream. In one preferred embodiment,the amount of lamotrigine may be approximately 2.5% of the total weightof the transdermal cream or gel.

III. Meloxicam/Topiramate/Lidocaine/Prilocaine Compounded Medication

In one aspect, a transdermal cream or gel may include lidocaine,prilocaine, meloxicam, and topiramate. The amounts of lidocaine,prilocaine, and meloxicam may be as stated above. Alternatively, otheramounts of lidocaine, prilocaine, and meloxicam may be used.

Topiramate may be characterized as an antiepileptic drug used to treatepilepsy or migraines. In one aspect, the amount of topiramate in thetransdermal cream or gel may be more than the other active ingredients,such as lidocaine, prilocaine, meloxicam, and/or other activeingredients.

The amount of topiramate in the transdermal cream may be betweenapproximately 0.5% and approximately 5.0% of the total weight of thetransdermal cream, or between approximately 1.5% and approximately 3.5%of the total weight of the transdermal cream. Preferably, the amount oftopiramate may be between approximately 2.0% and approximately 3.0% ofthe total weight of the transdermal cream. In one preferred embodiment,the amount of topiramate may be approximately 2.5% of the total weightof the transdermal cream or gel.

IV. Exemplary Method of Compounding

FIG. 1 depicts an exemplary method of compounding one or moremedications with a transdermal cream or gel 100. The method 100 mayinclude providing a base composition having one or more localanesthetics 102; and adding to the base a fine powder of medicationcomprising: one or more NSAIDs 104; one or more anticonvulsants 106; oneor more or nerve depressants 108; one or more muscle relaxants 110; oneor more NMDA receptor antagonists 112; and/or one or more opiate oropioid agonists 114. The transdermal cream or gel may includeadditional, fewer, or alternate steps and/or ingredients.

The method 100 may comprise providing a base composition 102. The basecomposition may comprise one or more local anesthetics 102. Primaryexamples of local anesthetics that the transdermal creams and basecomposition disclosed herein may employ include, but are not limited to,lidocaine, prilocaine, benzocaine, and/or tetracaine. The localanesthetics may comprise between approximately 0.1% and approximately5.0% by weight of the transdermal cream. Other amounts may be used,including those discussed elsewhere herein. The base composition mayinclude additional, fewer, or alternate ingredients.

Preferably, the base composition may include lidocaine and/orprilocaine. In one embodiment, the base composition may comprise anequal amount of lidocaine and prilocaine, such as between approximately2.0% and approximately 3.0% by weight of the transdermal cream. Otheramounts may be used, including those discussed elsewhere herein.

The method 100 may comprise adding to the base composition a fine powderof medication that includes one or more NSAIDs 104. NSAIDs may decreaseinflammation, swelling, and pain. NSAIDs that may be added to the basecomposition may include: (1) oxicams—meloxicam and piroxicam; (2)salicylic acid derivatives—aspirin, diflunisal, salsalate, andtrilisate; (3) propionic acids—flurbiprofen, ibuprofen, ketoprofen,naproxen, and oxaprozin; (4) acetic acids—diclofenac, etodolac,indomethacin, ketorolac, nabumetone, sulindac, and tolmetin; (5)fenamates—meclofenamate; and/or (6) COX-2 inhibitors—celecoxib,rofecoxib, and valdecoxib. Preferably, the final transdermal cream maycomprise a low concentration of an oxicam, such as meloxicam orpiroxicam, in a low amount between approximately 0.01% and 5.0% byweight of the final transdermal cream. In one embodiment, the finaltransdermal cream may include approximately 0.09% meloxicam by weight.Other amounts may be used, including those discussed elsewhere herein.

The method 100 may comprise adding to the base composition a fine powderof medication that includes one or more anticonvulsants 106.Anticonvulsants that may be added to the base composition may includelamotrigine and/or topiramate. The final transdermal cream may includean anticonvulsant in a low amount between approximately 0.1% andapproximately 5.0% by weight of the final transdermal cream. Preferably,the final transdermal cream may comprise approximately 2.5% of eitherlamotrigine or topiramate by weight. Other amounts may be used,including those discussed elsewhere herein.

The method 100 may comprise adding to the base composition a fine powderof medication that includes one or more nerve depressants 108. Nervedepressants that may be added to the base composition may includegabapentin and/or others. The low amount of nerve depressant in thetransdermal cream may be between approximately 0.1% and approximately5.0% of the total weight of the transdermal cream. Other amounts may beused.

The method 100 may comprise adding to the base composition a fine powderof medication that includes one or more muscle relaxants 110. The activeingredients that may be added to the base compositions in form of finepowder may comprise baclofen, carisoprodol, chlorzoxazone,cyclobenzaprine, dantrolene, diazepam, metaxalone, methocarbamol,orphenadrine, quinine sulfate, tizanidine, and/or other musclerelaxants. The low amount of muscle relaxant in the transdermal creammay be between approximately 0.1% and approximately 5.0% of the totalweight of the transdermal cream. Other amounts may be used.

The method 100 may comprise adding to the base composition a fine powderof medication that includes one or more NMDA receptor antagonists 112,such as ketamine. Ketamine may be useful because of its NMDA receptoractivity (antagonism). The low amount of NMDA receptor antagonist in thetransdermal cream may be between approximately 0.1% and approximately5.0% of the total weight of the transdermal cream. Other amounts may beused.

The method 100 may comprise adding to the base composition a fine powderof medication that includes one or more opiate or opioid agonists 114.C2 opiate agonists may include oxycodone, morphine, methadone,hydromorphone, and fentanyl. C3 opiate agonists may include hydrocodone,codeine, propoxyphene, butalbital, and pentazocine. The activeingredients that may be added to the base composition in the form offine powder may include the C2 and C3 opiate agonists named above and/ortramadol. The low amount of opiate or opioid agonist in the transdermalcream may be between approximately 0.1% and approximately 5.0% of thetotal weight of the transdermal cream. Other amounts may be used.

V. Another Exemplary Method of Compounding

A method of compounding medications with a transdermal cream using afine powder of medication is disclosed herein. In general, a basecomposition, such as a lidocaine/prilocaine cream, should be selected.The preparer, such as a pharmacist, should calculate the weight ofpowders needed. Then, the prepare should grind the medication, such astablets containing the medication, into fine powder and weigh theingredients. The preparer should triturate the powders together and wetwith dimethyl sulfoxide (DMSO) or Sterile Water for Irrigation. Thepreparer should bring to total weight with the lidocaine/prilocainecream and mix well. The mixture should be milled in an ointment mill asnecessary to acquire the desired consistency. After which, the preparershould mix thoroughly and package appropriately.

More specifically, FIG. 2 depicts an exemplary method of compoundingmedications with a transdermal cream 200. The method 200 depicted inFIG. 2 may be used to manufacture the transdermal creams discussedherein, including those discussed in relation to FIG. 1 above. Themethod 200 may include selecting a base composition 202; calculating anamount of active ingredients 204; grinding up the tablets containing theactive ingredients 206; wetting the mixture with DMSO or Sterile Waterfor Irrigation 208; bringing to total weight 210; and milling in anointment mill and mixing 212. The method 200 may include additional,fewer, or alternate actions.

The method 200 may include selecting a base composition 202 for atransdermal cream or gel. The base composition may include one or morelocal anesthetics, such as lidocaine and/or prilocaine. The base mayinclude approximately equal amounts of lidocaine and prilocaine. Thebase composition may be a transdermal cream and may originally haveapproximately 2.5% lidocaine and approximately 2.5% prilocaine byweight. Other initial amounts of lidocaine and/or prilocaine may beused. In one embodiment, the base composition that includes lidocaineand/or prilocaine may be used in an amount of approximately 24,000 gm.Other amounts of base composition may be used.

The method 200 may include calculating an amount of active ingredients204. The active ingredients may come in various size tablets. Notedherein, one of the transdermal cream embodiments, includes meloxicam andlamotrigine. For that embodiment, the ingredients may include 15 mgtablets of meloxicam, and approximately 1,500 of the 15 mg tables ofmeloxicam may be used. Tablets with other dosages of meloxicam may beused, and in different amounts. For instance, 7.5 mg or 30 mg tablets ofmeloxicam may be used.

The ingredients may also include 200 mg tablets of lamotrigine, andapproximately 3,000 of the 200 mg tablets of lamotrigine may be used.Tablets with other dosages of lamotrigine may be used, and in differentamounts. For instance, lamotrigine tablets ranging from 2 to 200 mg maybe used.

To manufacture the transdermal cream embodiment that includes meloxicamand lamotrigine, the following formulas may be used to identify theamount of tablet powder of meloxicam and lamotrigine needed:

-   -   a. Meloxicam:

avg tab weight_gm×tablets needed_=tablet powder needed_gm.

b. Lamotrigine:

avg tab weight_gm×tablets needed_=tablet powder needed_gm.

The foregoing formulas may be used with the numbers stated above. Forinstance, the composition may require 1,500 of the 15 mg tables ofmeloxicam, and 3,000 of the 200 mg tablets of lamotrigine. As a result,in one embodiment, 22.5 grams of meloxicam and 600 grams of lamotriginemay be mixed with other ingredients, such as 24,000 gm of lidocaine2.5%/prilocaine 2.5% cream, as well as 2,550 gm of dimethyl sulfoxide(DMSO). Instead of or in addition to lamotrigine, the medications addedmay include topiramate or other active ingredients. Instead of DMSO,Sterile Water for Irrigation may be used.

The method 200 may comprise grinding up the tablets containing theactive ingredients 206. In one aspect, an automatic grinder may be usedto grind up tablets containing one or more active ingredients into finepowder of medication. For instance, a Grindomix Mill may be used havinga 100 volt, 60 Hz motor and five liter plastic container. The mill mayhave a standard lid, knife, and scraper. A five liter stainless steelcontainer may be used that includes a knife holder. A knife of stainlesssteel may be used, and be autoclavable. The mill may have a plasticcover that is transparent.

The grinding up of the active ingredients into fine powder may allow formore precise amounts of each active ingredient in the final transdermalcream. This may be especially important when adding low amounts ofactive ingredients such that the final transdermal cream has lowconcentrations of various medications, which may reduce adverse allergicreactions to prolonged usage.

The method may include wetting the mixture with DMSO or Sterile Waterfor Irrigation 208. The DMSO and/or Sterile Water for Irrigation mayfacilitate the active ingredients penetrating the skin. After theingredients in fine powder form are weighed, the preparer may trituratethe powders of each ingredient together and wet with DMSO. For the24,000 gm amount of lidocaine/prilocaine cream noted above, DMSO may beused in an amount of approximately 2,550 gm. Other amounts of DMSO maybe used.

Instead of DMSO, the method may include wetting the mixture with only orprimarily Sterile Water for Irrigation. Sterile Water for Irrigation USPmay be a sterile, hypotonic, nonpyrogenic irrigating fluid orpharmaceutic aid (solvent), and may be composed of Sterile Water forInjection USP. It may be prepared by distillation and may contain noantimicrobial or bacteriostatic agents or added buffers. The pH may beabout 5.7, or between 5.0 and 7.0. Sterile Water for Irrigation may beintended for use only as a single-dose, and may be classified as asterile irrigant, wash, rinse, diluent and pharmaceutical vehicle.Instead of or addition to Sterile Water for Irrigation, Sterile Waterfor Injection or purified water may be used.

The method may include bringing to total weight with thelidocaine/prilocaine cream and mixing well 210. As noted elsewhereherein, after the fine powder of medication is mixed with thelidocaine/prilocaine base, the final transdermal cream may haveapproximately 2.0% by weight lidocaine, approximately 2.0% by weightprilocaine, approximately 0.09% by weight meloxicam, and approximately2.5% by weight either lamotrigine or topiramate. The final transdermalcream may have other active ingredients as well, including thosementioned herein.

The method 200 may include milling the mixture in an ointment mill asnecessary to acquire the desired consistency 212. After which, thepreparer may mix the milled mixture thoroughly and package it inappropriate containers.

VI. Exemplary Storage Characteristics

The transdermal creams discussed herein that are made using fine powderof medication may exhibit excellent storage characteristics, and avoidseparation and/or degradation of the active ingredients from a basecomposition for substantial lengths of time, such as six months orgreater. For example, Table I below depicts the results of a 198 daypotency test for a transdermal cream including meloxicam, lamotrigine,lidocaine, and prilocaine. As shown, there is little degradation of theactive ingredients. The sample was stored in approximately 20° C. to 25°C. (68° F. to 77° F.) conditions, and contained one large white tubewith cream in a clear bag.

TABLE I 198 Day Potency Test Expected % Test Analyte/SpecificationsAmount Units Results of EXP. Method Lamotrigine 2.5 % 2.463 98.5% HPLCSpecifications = N/A Lidocaine 2.0 % 1.927 96.4% HPLC Specifications =N/A Meloxicam 0.09 % 0.0962 106.9% HPLC Specifications = N/A Prilocaine2.0 % 2.118 105.9% HPLC Specifications = N/A

Table II below depicts the results of a 100 day potency test for atransdermal cream including meloxicam, topiramate, lidocaine, andprilocaine. As shown, there is little degradation of the activeingredients. The sample was stored in approximately 20° C. to 25° C.(68° F. to 77° F.) conditions, and contained one large white tube withcream in a clear bag.

TABLE II 100 Day Potency Test Expected % Test Analyte/SpecificationsAmount Units Results of EXP. Method Lidocaine 2.0 % 1.700 85.0% HPLCSpecifications = N/A Meloxicam 0.09 % 0.0945 105.0% HPLC Specifications= N/A Prilocaine 2.0 % 1.899 95.0% HPLC Specifications = N/A Topiramate2.5 % 2.368 94.7% HPLC Specifications = N/A

VII. Exemplary Methods of Compounding Using Fine Powder

An exemplary method of compounding may include grinding up tablets ofone or more active ingredients into a fine powder, and then adding thoseingredients in powder form to a transdermal cream or gel. The activeingredients that are ground up into a fine powder of medication mayinclude one or more NSAIDs, anticonvulsants, nerve depressants, musclerelaxants, antidepressants, NMDA receptor antagonists, opioid or opiateagonists, local anesthetics, and/or other active agents. The transdermalcream or gel may or may not have one or more pre-existing ingredientsprior to the addition of the fine powder of medication, such as one ormore pre-existing local anesthetics.

The method may include grinding up tablets of one or more localanesthetics into a fine powder. The local anesthetics ground up intopowder form may include lidocaine and/or prilocaine, or other agents. Anamount of lidocaine and/or prilocaine powder may be added to thetransdermal cream such that lidocaine comprises between approximately0.5% and approximately 7.0% by weight of the transdermal cream, and thatprilocaine comprises between approximately 0.5% and approximately 7.0%by weight of the transdermal cream. Other amounts may be used, includingthose discussed elsewhere herein.

The method may include grinding up tablets of one or more NSAIDs into afine powder of medication. The NSAIDs that are ground up may includemeloxicam, fluribiprofen, nabumetone, and/or other NSAIDs. The amount ofNSAIDs may be between approximately 0.05% and 25.0% by weight of thetransdermal cream. For instance, the transdermal cream may includemeloxicam in a low amount of between approximately 0.05% andapproximately 0.15% by weight of the transdermal cream, and/orflurbiprofen or nabumetone in an amount between approximately 5.0% andapproximately 25.0% of the transdermal cream by weight. Other amountsmay be used, including those discussed elsewhere herein.

The method may include grinding up tablets of one or moreanticonvulsants into the fine powder of medication. The anticonvulsantsthat are ground up may include lamotrigine, topiramate, and/or otheranticonvulsants. The transdermal cream may include an amount ofanticonvulsant of between approximately 1.0% and approximately 5.0% byweight of the transdermal cream. Other amounts may be used, includingthose discussed elsewhere herein.

The method may include grinding up tablets of one or more musclerelaxants into a fine powder of medication. The muscle relaxants thatare ground up may include baclofen, cyclobenzaprine, and/or other musclerelaxants. The transdermal cream may include an amount of musclerelaxant of between approximately 1.0% and approximately 5.0% by weightof the transdermal cream. Other amounts may be used, including thosediscussed elsewhere herein.

The method may include grinding up tablets of one or more opioid oropiate agonists into a fine powder of medication. The opioid or opiateagonists that are ground up may include C2 or C3 opiate agonists,tramadol, and/or others. The transdermal cream may include an amount ofopioid or opiate agonist of between approximately 1.0% and approximately5.0% by weight of the transdermal cream. Other amounts may be used,including those discussed elsewhere herein.

The method may include grinding up tablets of one or more NMDA receptorantagonists into a fine powder of medication. The NMDA receptorantagonists that are ground up may be ketamine and/or other antagonists.The transdermal cream may include an amount of NMDA receptor antagonistof between approximately 1.0% and approximately 40.0% by weight of thetransdermal cream. Other amounts may be used, including those discussedelsewhere herein.

The method may include grinding up tablets of one or more nervedepressants into a fine powder of medication. The nerve depressants thatare ground up may include gabapentin and/or other nerve depressants. Thetransdermal cream may include an amount of nerve depressant of betweenapproximately 1.0% and approximately 15.0% by weight of the transdermalcream. Other amounts may be used, including those discussed elsewhereherein.

The method may include grinding up tablets of one or more tricyclicantidepressants or other antidepressants into a fine powder ofmedication. The tricyclic antidepressants that are ground up may includeamitriptyline and/or other antidepressants. The transdermal cream mayinclude an amount of antidepressant of between approximately 1.0% andapproximately 15.0% by weight of the transdermal cream. Other amountsmay be used, including those discussed elsewhere herein.

The fine powder of each active ingredient that is ground up may be addedto a transdermal cream or gel separately or collectively. Themedications may comprise approximately 20%, approximately 30%, orapproximately 40% or more of a transdermal cream by weight. Otheramounts may be used, including those discussed elsewhere herein.Alternatively, administering low doses or applying transdermal creams orgels with low concentrations of one or more active ingredients mayminimize adverse side effects, such as adverse skin conditions that maydevelop with usage. Therefore, the method may include adding severalmedications in fine powder form to a transdermal cream or gel toalleviate the magnitude of any adverse skin conditions that may arise,while simultaneously providing a compounded therapy.

In specific embodiments, the two or more medications that are ground upinto a fine powder may include (1) a NSAID (such as meloxicam) and ananticonvulsant (such as lamotrigine and/or topiramate); (2) a NSAID(such as fluribiprofen or nabumetone), a nerve depressant (such asgabapentin), and a muscle relaxant (such as baclofen orcyclobenzaprine); or (3) a NSAID (such as fluribiprofen or nabumetone),a nerve depressant (such as gabapentin), and an antidepressant (such asamitriptyline). Other combinations of medications may be used.

In one aspect, an amount of fine powder of several medications may beground up and then added to a transdermal cream or gel. The severalmedications may include: (1) at least one local anesthetic, such aslidocaine and/or prilocaine, in an amount between approximately 1.0% andapproximately 7.0% of the transdermal cream by weight; (2) at least onenerve depressant, such as gabapentin, in an amount between approximately5.0% and approximately 15.0% of the transdermal cream by weight; (3) atleast one NSAID, such as flurbiprofen or nabumetone, in an amountbetween approximately 5.0% and approximately 25.0% of the transdermalcream by weight; and/or (4) at least one muscle relaxant, suchcyclobenzaprine, in an amount between approximately 0.5% andapproximately 4.0% of the transdermal cream by weight such that multipleailments may be addressed simultaneously. In one embodiment, thetransdermal cream may comprise, by weight of the transdermal cream,approximately 2.0% lidocaine, approximately 2.0% prilocaine,approximately 6.0% gabapentin, approximately 1.0% cyclobenzaprine, andapproximately 10.0% flurbiprofen or approximately 20% nabumetone. Theseveral medications may also include an opioid or opiate agonist, atricyclic or other antidepressant, a NMDA receptor antagonist, and/orother active ingredients.

In another aspect, an amount of fine powder of several medications maybe ground up and then added to a transdermal cream or gel. The severalmedications may include: (1) at least one local anesthetic, such aslidocaine and/or prilocaine, in an amount between approximately 1.0% andapproximately 7.0% of the transdermal cream by weight; (2) at least onenerve depressant, such as gabapentin, in an amount between approximately5.0% and approximately 15.0% of the transdermal cream by weight; (3) atleast one NSAID, such as flurbiprofen or nabumetone, in an amountbetween approximately 5.0% and approximately 25.0% of the transdermalcream by weight; and/or (4) at least one tricyclic antidepressant, suchas amitriptyline, in an amount between approximately 0.5% andapproximately 4.0% of the transdermal cream by weight. In oneembodiment, the transdermal cream may comprise, by weight of thetransdermal cream, approximately 2.0% lidocaine, approximately 2.0%prilocaine, approximately 6.0% gabapentin, approximately 1.0%amitriptyline, and approximately 10.0% flurbiprofen or approximately20.0% nabumetone. The several medications may also include an opioid oropiate agonist, a muscle relaxant, a NMDA receptor antagonist, and/orother active ingredients.

In another aspect, an amount of fine powder of several medications maybe ground up and then added to a transdermal cream or gel. Thetransdermal cream may include lidocaine in an amount betweenapproximately 0.5% and approximately 7.0% by weight of the transdermalcream; prilocaine in an amount between approximately 0.5% andapproximately 7.0% by weight of the transdermal cream; meloxicam in anamount between approximately 0.01% and approximately 5.0% by weight ofthe transdermal cream; and lamotrigine and/or topiramate in an amountbetween approximately 0.5% and approximately 5.0% by weight of thetransdermal cream. In one embodiment, the transdermal cream may compriseapproximately 2.0% by weight of both lidocaine and prilocaine,approximately 0.09% by weight meloxicam, and approximately 2.5% byweight lamotrigine and/or topiramate. As a result, the transdermal creamor gel may allow for the topical administration of lidocaine,prilocaine, meloxicam, and lamotrigine and/or topiramate simultaneouslyduring use. The several medications may also include an opioid or opiateagonist, a muscle relaxant, a NMDA receptor antagonist, a nervedepressant, other NSAIDs, other anticonvulsants, and/or other activeagents, including those discussed elsewhere herein.

VIII. Additional Exemplary Embodiments

The present embodiments may include the presence of DMSO and/or SterileWater for Irrigation, such as DMSO or Sterile Water for Irrigation in asufficient quantity to allow for the topical delivery of the activeingredients mentioned herein. The transdermal cream of the presentembodiments may be compounded to have no bulk ingredients in it. Forinstance, during the methods discussed herein, the DMSO may be removedand replaced with Sterile Water for Irrigation. The transdermal creammay be DMSO-free.

In one aspect, compounded meloxicam, topiramate (and/or lamotrigine),lidocaine, and prilocaine cream may contain strictly commerciallyavailable medications. DMSO, which may be in some cream embodimentsdisclosed herein, may be replaced with Sterile Water for Irrigation.Sterile Water for Irrigation may act as a primary or sole penetrationenhancer in some embodiments.

Although experimentation and investigation continues, it is believedthat some detriments may develop from a transition to a DMSO-freecompounded transdermal cream. It is believed that the removal of DMSOfrom certain compounds may decrease the effectiveness of the compoundgiven that the primary penetrant is no longer present. Also, patientsthat have received the previous compounded version containing DMSO mayexperience lower efficacy rates. It is also believed that the transitionof the formula may, at best, give the same efficacy that the patientspreviously had experienced, and, at worst, decrease efficacy due to theabsence of DMSO.

On the other hand, the use of Sterile Water for Irrigation instead ofDMSO may be cheaper and involve an easier method of manufacture. Also,Sterile Water for Irrigation is an FDA-approved commercially availablemedication.

In one aspect, a transdermal cream that permits the simultaneousadministration of multiple medications in low concentrations may beprovided. The transdermal cream may include lidocaine in an amountbetween approximately 0.5% and approximately 7.0% by weight of thetransdermal cream; prilocaine in an amount between approximately 0.5%and approximately 7.0% by weight of the transdermal cream; meloxicam inan amount between approximately 0.01% and approximately 5.0% by weightof the transdermal cream; and lamotrigine in an amount betweenapproximately 0.5% and approximately 5.0% by weight of the transdermalcream. In one embodiment, the transdermal cream may compriseapproximately 2.0% by weight of both lidocaine and prilocaine,approximately 0.09% by weight meloxicam, and approximately 2.5% byweight lamotrigine. As a result, the transdermal cream may allow for thetopical administration of lidocaine, prilocaine, meloxicam, andlamotrigine simultaneously during use. The transdermal cream may furtherinclude only or primarily Sterile Water for Irrigation as a penetrationenhancer or other component, and be devoid of DMSO or DMSO-free.

In another aspect, a transdermal cream that permits the simultaneousadministration of multiple medications in low concentrations may beprovided. The transdermal cream may include lidocaine in an amountbetween approximately 0.5% and approximately 7.0% by weight of thetransdermal cream; prilocaine in an amount between approximately 0.5%and approximately 7.0% by weight of the transdermal cream; meloxicam inan amount between approximately 0.01% and approximately 5.0% by weightof the transdermal cream; and topiramate in an amount betweenapproximately 0.5% and approximately 5.0% by weight of the transdermalcream. In one embodiment, the transdermal cream may compriseapproximately 2.0% by weight of both lidocaine and prilocaine,approximately 0.09% by weight meloxicam, and approximately 2.5% byweight topiramate. As a result, the transdermal cream may allow for thetopical administration of lidocaine, prilocaine, meloxicam, andtopiramate simultaneously during use. The transdermal cream may furtherinclude only or primarily Sterile Water for Irrigation for penetrationenhancement or as a wetting component, and/or be devoid of DMSO orDMSO-free.

In another aspect, a method of compounding one or more medications witha transdermal cream for the topical administration of a compoundedtherapy may be provided. The method may include grinding up one or moretablets of a NSAID, an anticonvulsant, a nerve depressant, a musclerelaxant, a NMDA (N-Methyl-D-aspartate) receptor antagonist, an opiateor opioid agonist, and/or antidepressant into a fine powder ofmedication. The method may include wetting the fine powder of medicationmixture with DMSO or Sterile Water for Irrigation. The method may alsoinclude adding the fine powder of medication to a transdermal cream orbase composition containing both lidocaine and prilocaine, thetransdermal cream including both lidocaine and prilocaine in an amountof between approximately 0.5% and approximately 7.0% by weight of thetransdermal cream, respectively. The method may include adding the finepowder of compounded medication to the starting transdermal cream orbase composition in a sufficient amount such that the final transdermalcream includes the compounded medication that is ground up in a lowamount of between approximately 0.01% and approximately 5.0% by weightof the transdermal cream. In one embodiment, an amount of ground upmedication is added to the base composition such that the finaltransdermal cream contains low concentrations of several activeingredients and is approximately 2.0% by weight lidocaine, approximately2.0% by weight prilocaine, approximately 0.09% by weight meloxicam, andapproximately 2.5% by weight either lamotrigine or topiramate. In oneembodiment, the transdermal cream may further include only or primarilySterile Water for Irrigation for penetration enhancement or as a wettingcomponent, and/or be devoid of DMSO or DMSO-free.

In another aspect, a method of compounding medications with atransdermal cream for the topical administration of a compounded therapymay be provided. The method may include grinding up tablets of two ormore medications into a fine powder of compounded medication. The two ormore compounded medications to be ground up may be selected from aNSAID, an anticonvulsant, a nerve depressant, a muscle relaxant, a NMDAreceptor antagonist, a local anesthetic, an antidepressant, and anopioid or opiate agonist. The method may include wetting the fine powderof compounded medication with DMSO or Sterile Water for Irrigation. Themethod may include then adding the fine powder of compounded medicationto a transdermal cream or gel such that the transdermal cream or gelallows for topical delivery of the two or more compounded medicationsfor simultaneous treatment of two or more ailments when the transdermalcream or gel is topically applied. The transdermal cream may furtherinclude only or primarily Sterile Water for Irrigation for penetrationenhancement or as a wetting component, and/or be devoid of DMSO or otherpenetration enhancers.

The present invention may be embodied in other forms without departingfrom the spirit or essential attributes thereof and, accordingly,reference should be had to the following claims rather than theforegoing specification as indicating the scope of the invention.Further, the illustrations of arrangements described herein are intendedto provide a general understanding of the various embodiments, and theyare not intended to serve as a complete description. Many otherarrangements will be apparent to those of skill in the art uponreviewing the above description. Other arrangements may be utilized andderived therefrom, such that logical substitutions and changes may bemade without departing from the scope of this disclosure.

This disclosure is intended to cover any and all adaptations orvariations of various embodiments and arrangements of the invention.Combinations of the above arrangements, and other arrangements notspecifically described herein, will be apparent to those of skill in theart upon reviewing the above description. Therefore, it is intended thatthe disclosure not be limited to the particular arrangement(s) disclosedas the best mode contemplated for carrying out this invention, but thatthe invention will include all embodiments and arrangements fallingwithin the scope of the appended claims.

1. A method of compounding medication with a transdermal cream for thetopical administration of a compounded therapy, the method comprising:grinding up one or more commercial tablets selected from a NSAID(Non-Steroidal Anti-Inflammatory Drug), an anticonvulsant, a nervedepressant, a muscle relaxant, a NMDA (N-Methyl-D-aspartate) receptorantagonist, an opiate or opioid agonist, and an antidepressant into afine powder of medication; and adding the fine powder of medication to atransdermal cream containing lidocaine in an amount betweenapproximately 0.5% and approximately 5.0% by weight of the transdermalcream and prilocaine in an amount between approximately 0.5% and 5.0% byweight of the transdermal cream.
 2. The method of claim 1, wherein thegrinding comprises grinding up one or more commercial tablets of theNSAID into the fine powder of medication such that the transdermal creamincludes an amount of the NSAID of between approximately 0.05% andapproximately 0.15% by weight of the transdermal cream, the NSAID beingmeloxicam.
 3. The method of claim 1, wherein the grinding furthercomprises grinding up one or more commercial tablets of theanticonvulsant into the fine powder of medication such that thetransdermal cream includes an amount of the anticonvulsant of betweenapproximately 2.0% and approximately 3.0% by weight of the transdermalcream, the anticonvulsant being lamotrigine or topiramate.
 4. The methodof claim 1, wherein the grinding comprises grinding up one or morecommercial tablets of the NSAID into the fine powder of medication, theNSAID being meloxicam, and one or more commercial tablets of theanticonvulsant into the fine powder of medication, the anticonvulsantbeing one of topiramate and lamotrigine, wherein after the fine powderof medication is added to the transdermal cream, the transdermal creamincludes meloxicam in an amount of between approximately 0.05% andapproximately 0.15% by weight of the transdermal cream and the one oftopiramate and lamotrigine in an amount of between approximately 2.0%and approximately 3.0% by weight of the transdermal cream.
 5. (canceled)6. The method of claim 1, further comprising wetting the fine powder ofmedication with dimethyl sulfoxide (DMSO) or Sterile Water forIrrigation before adding the fine powder of medication to thetransdermal cream.
 7. The method of claim 6, wherein the grindingcomprises grinding up one or more commercial tablets of the NSAID intothe fine powder of medication such that the transdermal cream includesan amount of the NSAID of between approximately 0.05% and approximately0.15% by weight of the transdermal cream, the NSAID being meloxicam. 8.The method of claim 6, wherein the grinding further comprises grindingup one or more commercial tablets of the anticonvulsant into the finepowder of medication such that the transdermal cream includes an amountof the anticonvulsant of between approximately 2.0% and approximately3.0% by weight of the transdermal cream, the anticonvulsant beinglamotrigine or topiramate. 9-10. (canceled)
 11. A method of compoundingmedications with a transdermal cream for the topical administration of acompounded therapy, the method comprising: grinding up one or morecommercial tablets of each of two or more medications into a fine powderof medication, the two or more medications comprising meloxicam and atleast one of topiramate and lamotrigine; and adding the fine powder ofmedication to a transdermal cream containing lidocaine in an amountbetween approximately 0.5% and approximately 5.0% by weight of thetransdermal cream and prilocaine in an amount between approximately 0.5%and 5.0% by weight of the transdermal cream. 12-13. (canceled)
 14. Themethod of claim 11, wherein after the fine powder of medication is addedto the transdermal cream, the transdermal cream includes meloxicam in anamount of between approximately 0.05% and approximately 0.15% by weightof the transdermal cream and at least one of topiramate and lamotriginein an amount of between approximately 2.0% and approximately 3.0% byweight of the transdermal cream.
 15. The method of claim 11, furthercomprising wetting the fine powder of medication with dimethyl sulfoxide(DMSO) or Sterile Water for Irrigation. 16-17. (canceled)
 18. The methodof claim 15, wherein after the fine powder of medication is added to thetransdermal cream, the transdermal cream includes meloxicam in an amountof between approximately 0.05% and approximately 0.15% by weight of thetransdermal cream and at least one of topiramate and lamotrigine in anamount of between approximately 2.0% and approximately 3.0% by weight ofthe transdermal cream.
 19. A method of making a compounded transdermalcream, the method comprising: adding one or more fine powders ofmedication to a volume of lidocaine and prilocaine cream 2.5%/2.5%,wherein the medication is selected from a NSAID (Non-SteroidalAnti-Inflammatory Drug), an anticonvulsant, a nerve depressant, a musclerelaxant, a NMDA (N-Methyl-D-aspartate) receptor antagonist, an opiateor opioid agonist, and an antidepressant.
 20. The method of claim 19,further comprising wetting at least one of the one or more fine powdersof medication with dimethyl sulfoxide (DMSO) or Sterile Water forIrrigation before adding to the lidocaine and prilocaine cream2.5%/2.5%.
 21. The method of claim 19, wherein the selected medicationcomprises meloxicam in an amount between approximately 0.05% andapproximately 0.15% by weight of the compounded transdermal cream. 22.The method of claim 21, further comprising wetting the fine powder ofmeloxicam with dimethyl sulfoxide (DMSO) or Sterile Water for Irrigationbefore adding to the lidocaine and prilocaine cream 2.5%/2.5%.
 23. Themethod of claim 19, wherein the selected medication comprises one oflamotrigine and topiramate in an amount between approximately 2.0% andapproximately 3.0% by weight of the compounded transdermal cream. 24.The method of claim 23, further comprising wetting the fine powder ofthe one of lamotrigine and topiramate with dimethyl sulfoxide (DMSO) orSterile Water for Irrigation before adding to the lidocaine andprilocaine cream 2.5%/2.5%.
 25. The method of claim 19, wherein theselected medication comprises meloxicam in an amount betweenapproximately 0.05% and approximately 0.15% by weight of the compoundedtransdermal cream and one of lamotrigine and topiramate in an amount ofbetween approximately 2.0% and approximately 3.0% by weight of thecompounded transdermal cream.
 26. The method of claim 25, furthercomprising wetting the fine powders of meloxicam and the one oflamotrigine, and topiramte with dimethyl sulfoxide (DMSO) or SterileWater for Irrigation before adding to the lidocaine and prilocaine cream2.5%/2.5%.
 27. The method of claim 19, further comprising grinding upone or more commercial tablets of at least one selected medication intoa fine powder to form the fine powder of the selected medication. 28.The method of claim 27, further comprising wetting at least one of theone or more fine powders of medication with dimethyl sulfoxide (DMSO) orSterile Water for Irrigation before adding to the lidocaine andprilocaine cream 2.5%/2.5%.
 29. The method of claim 27, wherein theselected medication comprises meloxicam in an amount betweenapproximately 0.05% and approximately 0.15% by weight of the compoundedtransdermal cream, and wherein the method further comprises grinding upone or more commercial tablets of meloxicam to form the fine powder ofmeloxicam.
 30. The method of claim 28, further comprising wetting thefine powder of meloxicam with dimethyl sulfoxide (DMSO) or Sterile Waterfor Irrigation before adding to the lidocaine and prilocaine cream2.5%/2.5%.
 31. The method of claim 27, wherein the selected medicationcomprises one of lamotrigine and topiramate in an amount betweenapproximately 2.0% and approximately 3.0% by weight of the compoundedtransdermal cream, and wherein the method further comprises grinding upone or more commercial tablets of the one of lamotrigine and topiramateto form the fine powder of the one of lamotrigine and topiramate. 32.The method of claim 31, further comprising wetting the fine powder ofthe one of lamotrigine and topiramate with dimethyl sulfoxide (DMSO) orSterile Water for Irrigation before adding to the lidocaine andprilocaine cream 2.5%/2.5%.
 33. The method of claim 27, wherein theselected medication comprises meloxicam in an amount betweenapproximately 0.05% and approximately 0.15% by weight of the compoundedtransdermal cream and one of lamotrigine and topiramate in an amount ofbetween approximately 2.0% and approximately 3.0% by weight of thecompounded transdermal cream, and wherein the method further comprisesgrinding up one or more commercial tablets of the meloxicam and the oneof lamotrigine and topiramate to form the fine powders of meloxicam andthe one of lamotrigine and topiramate.
 34. The method of claim 33,further comprising wetting the fine powders of meloxicam and the one oflamotrigine, and topiramate with dimethyl sulfoxide (DMSO) or SterileWater for Irrigation before adding to the lidocaine and prilocaine cream2.5%/2.5%.